| NPI | 1821384843 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: OH 34.011803) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 34.011803) |
| Enumeration Date | 2011-06-28 |
| Last Update Date | 2020-11-24 |